Nope, now that the inside info has been revealed, I will definitely be more pro-active in my fight. I knew insurance companies were crooked anyway, now I just have the inside confirmation!! I will have them pull THEIR files to see what was done, and have audits of their accounts....see how they like a lil shug avery pee in their throats!!
When I worked for a major insurance carrier timely filing appeals were at the sole discretion of the approver who happened to get the appeal. Not much in the way of guidelines.
QuoteWhen I worked for a major insurance carrier timely filing appeals were at the sole discretion of the approver who happened to get the appeal. Not much in the way of guidelines.YES exactly Michele. I'm scratching my head wondering why anyone would be upset over a "gift" of kindness from a claims examiner in a good mood. LOL Actually you named the title given exactly it was called "Examiner discretion" The longer you worked there the more you had. No where is it written that any claims person arbitrarily, and depending on mood DENY or cut a claim using discretion. I never even suggested or hinted that in any of my posts.
I have to laugh I have a claims processing background also in some of the largest insurance companies and it is all true. I can tell you without a doubt that we have timely filing guidelines and I did have the power to make a judgement call on whether something would be paid or not after my research. There are multiple reasons and not "mood" on why I would give consideration. Just like any job sometimes common sense has to play a role. Life is not black and white - it is all shades of grey. Example:You send something in timely. Call the insurance and told it is not on file. You send it again. Told it is not on file. Now you are past timely. You submit the claim anyways. I receive it and in your letter, you state you spoke to so-and-so. Swearing you submitted and so-and-so was looking into it and you never received a call back and blah, blah, blah. Red flag went up as soon as I seen name so-and-so. You as the biller for a provider do not know that me as a claims processor, happens to know that so-and-so was under investigation and was just fired three days ago because so-and-so was not doing her job. Will I consider your request - YES Common sense and judgement tells me that you are possible right because 'I' have the inside scoop.